Week 3 Flashcards
Give two risk factor for a developmental dislocation dysplasia?
Breech position in utero or at deliver
Club foot, torticollis
When examining a patient for DDH what is down in LOOK, FEEL and MOVE?
LOOK - asymmetry
FEEL - click/clunk
MOVE - check abduction
Name two instability tests for diagnosing DDH?
- Barlow - attempt to dislocate/sublux a hip that is in joint by flexion adduction
- Ortolani - attempt to relocate a dislocated hip by abduction
When diagnosing DDH - what should be looked for on x-ray?
Calcified epiphysis > 3-6m
What are three treatment principles for DDH?
- relocate hip
- splint it while it stabilises
- monitor acetabular development
Give four suspicious history features (red flags) for back pain?
- Non-mechanical pain
- Systemic upset
- New neurological deficit
- Saddle anaesthesia +/- bladder upset
Give two examples of nerve irritation tests you would do when neurologically examining a patients back?
Straight leg raise
Femoral stretch test
What are the myotomes for hip flexion?
L1/L2
What are teh myotomes for knee extension?
L3/L4
What are the myotomes for foot dorsiflexion and EHL?
L5
What are the myotomes for ankle plantarflexion
S1/S2
How do you test hip flexion L1/L2?
Ask patient to push up against your hand
How do you test knee extension L3/4?
Ask patient to straighten knee against your hand
What myotome is extension of the great toe?
L5
How do you test the patients plantar flexion of foot S1/2?
Ask patient to stand on tip toes
What back pain conditions can x-rays be useful in?
Spinal stenosis or spinal claudication
What is the main first line investigation for back pain?
MRI
Name four more investigations for back pain other than MRI?
- Diagnostic facet injection
- Contrast enhanced CT
- Provocation discography
- Selective nerve block/ablation
In back pain - what are myelograms useful for detecting?
Spinal stenosis
What is sciatica?
Any sort of buttock or leg pain not obviously coming from hip, knee or ankle
What problems result from a slipped disc - disc prolapse?
Back and leg problems (pain) often accompanied by neurological disturbances
What presents commonly with episodic back pain, onset of leg pain +/- neurology, leg pain becoming dominant and can affect myotomes and dermatomes?
Disc prolapse
When does a prolapsed disc become a surgical emergency?
When cauda equina symptoms/signs
How are normal disc prolapses treated?
Settle in a few months on their own
How is back pain managed conservatively?
- Short bed rest
- Anti-inflammatory +/- muscle relaxant
- Mobilise thereafter
- Return to normal activity
Name three adverse factors in spinal surgery?
- Litigation
- Dispute with DSS
- Chronic pain syndrome/behaviour
What type of syndromes are back pain, chronic fatigue syndrome, fibromyalgia,IBS, migraine?
Dysfunctional syndromes
What are these symptoms: pain at tip of coccyx, whole leg pain, numbness and giving away, absence of pain free spells, intolerance of treatment and emergency admission?
Behavioural symptoms
Name 4 features of the deformity scoliosis?
- Rotational component
- Lateral bend component
- Rib deformities
- Visceral abnormalities
Name four common congenital scoliosis subtypes?
- Wedge vertebra and hemivertebra (defects of formation)
2. Unilateral bar and block vertebra (defects of segmentation)
What is Heuter - Volkmann’s law in scoliosis?
Increased pressure across an epiphyseal plate inhibits growth
What genetic fault is there in scoliosis?
Melatonin receptors
Name three conditions that produce a secondary scoliosis?
- Neuromuscular
- Tumours
- Spina bifida
What management type are serial corrective casts, bracing, corrective exercises and electrical stimulation in scoliosis?
Non-operative
What spinal condition involves the centre of gravity anterior to spine with a high pre-load?
Kyphosis
What is spondylolysis?
A defect in the pars interarticularis of the vertebra
What is spondylolisthesis?
Forward slippage on one vertebra on another
What grade is spondyloptosis?
5
In spondylolisthesis what is grade 1 or 2?
Abnormal neighbouring discs
In spondylolisthesis what is grade 3 +?
Combined discogenic + nerve root problem
Is history of cancer a red flag in back pain?
Yes
Give two features of cauda equina symptoms?
Various urinary upsets
Painless retention with overflow
What must be done in the initial assessment of a spinal fracture?
Immobilise and x-ray
After initial assessment of a spinal fracture - what is involved in neurological examination?
Establish motor and sensory level (attention to saddle area)
Where is the most common thoracolumbar injury occuring?
T12 or L1
Name three incomplete patterns of spinal cord injury?
- Central cord
- Brown-Sequard
- Anterior cord
What incomplete pattern of spinal cord injury is typically hyperextension injury, arms worse than legs and the prognosis is variable but generally good?
Central cord
Give two features of Brown-Sequard paralysis?
- Paralysis on ipsilateral side
2. Hypaesthesia on contralateral side
What incomplete pattern of spinal cord injury involves motor loss, loss of pain and temperature sense, deep touch, position and vibration is preserved, may have traumatic or vascular cause and the prognosis is poor?
Anterior cord
What spinal condition occurs in 50+, historically involves manual workers, obesity, limited walking capacity and heavy or tired legs?
Spinal claudication
Give three features on spinal claudication?
- Relieved by flexing
- Uphill often not bad
- Cycling easy
Gives three features of vascular claudication?
- Relieved by standing
- Uphill bad
- Cycling bad
What spinal condition involves stiffness in the morning, difficulty sitting, driving and standing, worse with extension and better with activity?
Facet arthropathy
Name three ways to increase growth in bones?
- Periosteal release
- Fractures
- Blood flow
What is a result of loss of medial longitudinal arch of foot?
Flat feet
Give three forms of intoeing?
- Femoral neck anteversion
- Internal tibial torsion
- Metatarsus adductus
What form of inteoing occurs in >4 years, has ligamentous laxity and unwinds slowly?
Femoral neck anteversion
What form of intoeing occurs in
ITT
After 2 years of age is significant bow legs a problem
Yes
At what age does knock knees peak?
3.5
Is > 8cm standing intermalleolar at distance 11 years a sign of knock knees?
Yerp
What must you examine if a patient has anterior knee pain?
Knee and HIP
Name 4 congenital orthopaedic conditions?
- Clubfoot
- Congenital vertical talus
- Neurofibromatosis
- Skeletal dysplasias
Name 4 neuromuscualr orthopaedic conditions?
- CP
- Tip toe walking
- DMD
- Cavus foot
What is the known genetic mutation for NF 1?
17q11.2
What orthopaedic condition involves cage au lait spots, neurofibromas, axillary/groin freckling, Lisch nodules, pseudoarthrosis, kyphoscoliosis?
NF1
What condition is defined by frontal bossing, midface hypoplasia, rhizomelic disproportion, genu varum, trident hand and motor delay?
Achondroplasia
What condition is a persisting qualatative motor disorder appearing before the age of three years, due to non progressive damage to the encephalon occurring before the growth of the CNS is complete?
CP
What condition is x-linked recessive, occurs in boys 2-5, involves dystrophin gene and is progressive?
DMD
